Ensures the decision to downcode an insurance claim is recognized as an adverse determination; prohibits health plans from reversing or altering medical necessity determinations made by a utilization review agent or external appeals agent as a result of an audit of claims.
Ensures the decision to downcode an insurance claim is recognized as an adverse determination; prohibits health plans from reversing or altering medical necessity determinations made by a utilization review agent or external appeals agent as a result of an audit of claims.
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{# E23 (Nick, ruling section 1 answer 10): quoting a bill or a court opinion works
the way quoting a news article works. Select a passage above and the same panel
opens: the passage goes to the official you choose, with this document's own
address as its source and its own type. #}